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Randomized trial of McRoberts versus lithotomy positioning to decrease the force that is applied to the fetus during

Sarah H Poggi1, Robert H Allen, Chirag R Patel

  • 1Georgetown University Hospital, Department of Obstetrics and Gynecology, Washington, DC 20007, USA. shp2@gunet.georgetown.edu

American Journal of Obstetrics and Gynecology
|October 7, 2004
PubMed
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The prophylactic McRoberts maneuver does not reduce delivery force during vaginal birth. This study found no significant difference in force needed for fetal head delivery with or without the McRoberts maneuver.

Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Medicine
  • Clinical Biomechanics

Background:

  • Shoulder dystocia is a significant obstetric complication.
  • The McRoberts maneuver (maternal hip hyperflexion) is sometimes used prophylactically to reduce delivery complications.
  • The efficacy of prophylactic McRoberts maneuver in reducing delivery force remains unclear.

Purpose of the Study:

  • To objectively evaluate if prophylactic maternal hip hyperflexion (McRoberts maneuver) reduces the force exerted during vaginal delivery.
  • To compare delivery forces between the lithotomy and McRoberts positions.

Main Methods:

  • Prospective randomized study comparing lithotomy and McRoberts positions in multiparous women.
  • Force-measuring system with sensors in a custom glove to record force on the fetal head.

Related Experiment Videos

  • Primary outcomes: peak force, peak force for anterior shoulder delivery, and peak force rate.

    • Main Results:

    • No statistically significant difference in peak force (7.2 lbs vs 8.0 lbs, P=.5) between lithotomy and McRoberts positions.
    • No significant difference in peak force for anterior shoulder delivery (6.7 lbs vs 7.1 lbs, P=.7) or peak force rate (32.3 lbs/sec vs 29.1 lbs/sec, P=.7).
    • Subjective difficulty of delivery correlated with peak force (R²=0.53, P=.001).

    Conclusions:

    • Prophylactic use of the McRoberts maneuver does not reduce traction force on the fetal head during vaginal delivery in multiparous patients.
    • The routine prophylactic application of the McRoberts maneuver warrants re-evaluation.
    • Further research may be needed to clarify its role in managing shoulder dystocia.